@Nate, I’m late to the party. Reading about your experience shortly before Thanksgiving I feel sad that you’re experiencing this mess and thankful that I don’t have these problems. I have other problems, but am thankful I don’t have this kind of mess going on instead. I’m also impressed you can achieve the level of fitness you reach with so much sickness interfering with training and recovery.

Some of the following may repeat earlier suggestions.

I saw a couple of articles that might be interesting. Based on what we know of your personality, I’m assuming you have these covered. (I’ll see your Leadville nutrition/hydration plan spreadsheet and raise you an itinerary spreadsheet for a two month trip to Japan with a detailed tourist schedule most weekends, prioritized activities and alternates, train schedules, hotels, cost projections and backup plans for backup plans for everything. )

Phil Burt literally wrote the book on bike fit. He tells us about Olympic glory, UCI rule changes and why he made Team GB brush their teeth

Other thoughts that may help in order of expected chance of benefit.

The walking petri dishes in your household are at least part of your problem. Mine is 18 now, so past that. Wearing a biohazard suit 24x7 is the best, legal option to deal with that. The next best, legal option is about 2^100 worse.

Get a comprehensive, top-to-bottom, cross-system exam from a respected, academic/research hospital that has experience with chronic respiratory infections. Ask your doctor(s) and executive health network for recommendations. The exam may or may not give you a complete solution, but should help narrow your focus if nothing else. Of all the suggestions I and others have, this one is the most likely to succeed (other than that biohazard suit) and the most likely to give you clear reasons and actions.

The people who’ve suggested your gut bacteria is a mess after nine rounds of antibiotics are probably right. The people who tell you gut bacteria are a part of your problem are probably right too. You don’t (and can’t, at this stage) know what’s normal gut bacteria for you, so don’t know what you’re tracking back toward, but you can apply some general guidelines–probably (no better reference, so it’s at least a starting place). I recommend research in medical literature, consulting your doctor, executive health network, and recommendations from a comprehensive exam to determine which combination of pre/pro/etc. biotics are best.

You mention cholesterol and testosterone numbers that are not low, but below the mean. (Note, 150 total cholesterol is “very good” but, yeah, low and 69 HDL is the low end of “good.”) Every year my doctor tells me that testosterone synthesis requires cholesterol and that he hesitates to prescribe statins to men with signs of coronary artery inflammation (early warning of cardiac disease) and normal cholesterol levels, even though that’s the normal treatment. He says lowering normal cholesterol levels is unlikely to improve coronary artery inflammation, but will lower testosterone levels, which will cause a host of other issues. (This makes sense to me.) I can’t remember if he says cholesterol/testosterone are linked to immune function. Either way, maybe aim for higher, but still normal, cholesterol to see if helps. It’s a better solution than changing the other cause of lower testosterone (marriage ).

Consider a full reset (elimination approach). If so, do your research, then make the mother of all spreadsheets and be rigorously scientific, trying and rating all combinations (where k = 1 … n) to find the minimum intervention that delivers the least infection. This is a long term project, may result in a lot of misery while you’re working through the protocol, and may only reveal that none of the things you’re doing now helps. Not likely, but if that’s the outcome, at least you know the thousand combinations that don’t work. Of course, feel free to add back no-change items after the protocol if you think they deliver other benefits. And, when the kids pass petri dish stage, you may want to retest the final interventions to see which are still needed.

Begin suggestions that have very low likelihood of addressing respiratory infections, but may be helpful or beneficial in other ways. YMMV significantly.

My doctor says, “Studies show multivitamins are a waste of money.” He also advises his patients take them and takes them himself. They’re an inexpensive safety net that are at least as likely to help as hurt. He is adamant about chelated minerals in the mix because they’re more bioavailable or something similar. Based on that, I suggest considering a good multi with chelated minerals (including magnesium) and simplify the rest of your regimen. FWIW, he also recommends a quality probiotic, fish oil, and D3-5000 (specifically a K2-D3 for me) on top of the multi.

Multivitamins aside, I don’t think taking food pills in place of food makes much sense–nor do I think pills are likely as the food to deliver benefits. If you can’t find the food, find out why it supposedly helps (what nutritional elements) and look for alternate food sources. (I take the supplements noted above, but eat food sources regularly. In the case of D3, I spend time outside regularly.)

For tea, many Asian grocery stores and Amazon carry sencha (green tea). Get a Japanese brand (labeling from Japan). Get a tea ball, inexpensive electric kettle, candy thermometer, and a Sharpie. Spend 30 minutes finding the setting on the kettle to get 140-158 degF water (too hot burns the tea). Mark it with the Sharpie. Make tea with hot water (keep the thermometer to check the water so you don’t burn the tea). Enjoy. Sencha smells nice, so also acts as an air freshener .

I see jiaogulan loose leaf on Amazon and assume you may find it at an Asian grocery store. Same drill. Internet tea snobs recommend temperatures ranging from 140 to 212 degF, so you could probably use the same setting as sencha. I did see an article referencing a Chinese research paper that said boiling, while it tastes bad, releases more rare earths or something. If you go that route, put another mark on the kettle so superhot water doesn’t burn the tea. According to WebMD, jiaogulan tea is “possibly effective” for reducing cholesterol levels, with “insufficient evidence” for anything else due to lack of studies. I’m not sure you need lower cholesterol given the cholesterol note above, so maybe more reason to seek to increase cholesterol if using jiaogulan.

As a side benefit, drinking all that tea will improve hydration. But, seriously, it will and hydration is a good thing when fighting or seeking to avoid infections.

Personal anecdotal evidence with no measurable data: Honey seems to help me overcome the infection of any type faster. YMMV. You can add it to sencha as a sweetener, though I find plain sencha good too.

Another personal anecdote: I had a case of siladenitis (minor, but miserable) recently. My doctor recommended swishing lemon juice several times a day to provoke salivation. Based on how my mouth felt afterward, I think it also whacks oral bacteria and maybe viruses. Logic suggests to me that reducing oral bacteria could reduce the risk of sinus/respiratory infection (dental hygiene note above) or reduce the load on your immune system, at least slightly. Check with your dentist about the effect of long term use on dental enamel before making that a daily thing. You might gain a similar benefit with regular brushing.

@Nate I am no expert but bad immunity is a sign of not the best microbiome. Have you done a stool test for microbiome quality? There are a lot of probiotics out there. The one I use and recommend is called VSL#3. THey ship it to you frozen in ice,
Check out two books on this topic.

I’ve had pretty much exact experience as you including same sinus surgery. As some have said, kids are walking diseases- mine were the same when younger.

So what did I do after surgery to fix… I found a link between swimming and sinus infections. Do you swim much? Since stopping (yes stop) freestyle stroke, I have not had a sinus infection that required antibiotics. Either the water was flushing my own nasal yuck into my sinuses or the pool yuck when I was breathing during freestyle stroke.

Hi Nate
I’m a urologist and I see many people with recurrent urinary tract infections (UTI) which I believe may be an analogous situation to what you are experiencing. When a mucosal lined organ ( bladder, sinus etc) gets an infection it’s innate resistance to the next infection is lowered until there has been complete resolution of the inflammatory process. In the case of uti’s we have several steps which are very successful

Treat the current infection fully based on culture of the causative bug - this may need a three week course of antibiotics

Continue a prophylactic dose of antibiotics eg cephalexin 500 mg each night for three to six months

Address any other contributing factors eg hormone deficiency, nutrition etc.
This approach works in the great majority and after three to six months the mucosa has fully recovered and it’s often the case that infections don’t come back.
This type of approach importantly is much less likely to give rise to resistant bacteria than is frequent short ( often inadequate) courses of full strength antibiotics.
If you haven’t already tried this approach I think it would be worthwhile.
Dave
PS love the trainer road product- it’s giving me gear results as a crunched 50 yr old surgeon pretty new to cycling

I used to take apple cider vinegar shots daily, oh man it was the worst. I didn’t notice a change.

tofel:

Are there any news regarding G6PDD? What did the doctor(s) say?

I haven’t seen another doctor since I posted this but it’s on my list. I planned on eating a bunch of fava beans one day (it’s a trigger for G6PDD) and see how I feel. It looks like G6PDD is more common in men of African or Middle Eastern descent, which I am not (according to 23andme and ancestry.com.

jmjf:

Get a comprehensive, top-to-bottom, cross-system exam from a respected, academic/research hospital that has experience with chronic respiratory infections. Ask your doctor(s) and executive health network for recommendations. The exam may or may not give you a complete solution, but should help narrow your focus if nothing else. Of all the suggestions I and others have, this one is the most likely to succeed (other than that biohazard suit) and the most likely to give you clear reasons and actions.

That’s the next step after local docs. I think I can get into the Mayo Clinic in MN and this is the sort of thing they do.

jmjf:

The people who’ve suggested your gut bacteria is a mess after nine rounds of antibiotics are probably right. The people who tell you gut bacteria are a part of your problem are probably right too. You don’t (and can’t, at this stage) know what’s normal gut bacteria for you, so don’t know what you’re tracking back toward, but you can apply some general guidelines–probably (no better reference, so it’s at least a starting place).

I’ve got a gut biome at home test coming in the mail. It lets me do three samples over time. I’m going to do one this week, then another in about two months and probably one right when I get sick again.

The other podcast guys are most likely going to do it too so we can compare results. I’m guessing the company will also have some guidelines for what a healthy gut looks like.

jmjf:

Either way, maybe aim for higher, but still normal, cholesterol to see if helps. It’s a better solution than changing the other cause of lower testosterone (marriage ).

It’s been a while since either of these were tested. I’m hoping I can get it all at once if I go to a place like the Mayo Clinic.

jmjf:

Consider a full reset (elimination approach). If so, do your research, then make the mother of all spreadsheets and be rigorously scientific, trying and rating all combinations (where k = 1 … n) to find the minimum intervention that delivers the least infection.

Right now I’m on the opposite approach; I’m doing EVERYTHING I can. I’ll keep doing that until my next sinus infection. If that never happens (or I even get through this winter without one) then I’ll probably keep doing everything forever!

One thing I’m not doing right now is a complete elimination diet. I’m taking dairy out right now though.

jmjf:

Based on that, I suggest considering a good multi with chelated minerals (including magnesium) and simplify the rest of your regimen. FWIW, he also recommends a quality probiotic, fish oil, and D3-5000 (specifically a K2-D3 for me) on top of the multi.

I don’t do a multi vitamin, but I do do a probiotic, fish oild and 5000 IUs of D3 a day.

I’m a urologist and I see many people with recurrent urinary tract infections (UTI) which I believe may be an analogous situation to what you are experiencing. When a mucosal lined organ ( bladder, sinus etc) gets an infection it’s innate resistance to the next infection is lowered until there has been complete resolution of the inflammatory process. In the case of uti’s we have several steps which are very successful

My mom was thinking the same thing. She’s had a lot of sinus infections in her life too. When she took a 2nd level antibiotic for a long time (not sure how long) she stopped getting sinus infections. This is on the list to talk to my doctor about it. Thank you.

I did a test the other night and had a hamburger and a steak. I had really frothy urine (which is a sign of protein in the urine). I think I need to do a 24 hour urine analysis while I eat a good amount of protein to see if there’s protein in my urine (and potentially have a kidney issue).

Some of the things I learned from those two books. The first 3 things are obvious.

Avoid processed food. (Duh!)

Eat foods with high fiber. These foods take longer to digest and ferment in the gut, creating the right chemicals.

Avoid excess sugar.

The gut lining has more nerve cells than the brain.
5… The gut lining has more bacteria than the total cells in our entire body.
6 There is an astounding amount of emerging evidence about Gut and immunity.

There is also an amazing amount of emerging evidence about Gut health and mental state.

Gut health is highly correlated to a good weight. ( I am working on this right now as I am 30lbs overweight).

Probiotics that you take only have a temporary effect (Like the VSL#3) I mentioned but that is a good start and they build a strong foundation for your gut.

Apply the above and avoid the Leaky gut syndrome that causes a whole host of symptoms.

Medicines that we take, particularly antibiotics destroy the gut. Unfortunately, in your case, those powerful drugs may have destroyed your gut lining, I would suggest taking Probiotics (VSL#3)and eating fermented food like Kimchi, eating whole plant-based food (read Fiber) are things you should be doing right away.

There is a lot more but that is all I can remember off the top of my head. Read those books.
I wish you a good health, Nate.

With all of those antibiotics, how is your gut health? I see a priobiotic gummy on your supplement list but those are often not that powerful. Without a good intestinal flora your immune system is likely compromised. Might be worth looking into.

Hi @Nate it might be that you have food and chemical intolerances. If so trying different medications could just make you sicker. My wife suffered from sinusitis for decades, but when our first son’s illnesses cleared up totally within a week on a low-food-chemical diet, she tried it and has never had another bout. You can find out more at http://www.failsafediet.com and https://www.slhd.nsw.gov.au/rpa/allergy/resources/foodintol/friendlyfood.html. I wasn’t a believer until I saw the total change in our son, but now I have to recommend that you try a low food chemical diet for a week. It might just change your life. I hope it does.

Nate, I hope that you can find relief. Having two children (6 and 4) I know what it’s like to constantly feel like you’re battling illness. This is not medical advice, but common sense, wash your hands a lot, be extra mindful of touching your face, and use hand sanitizer regularly. It’s stupid, but I think it can go a long way.

I’ve got a gut biome at home test coming in the mail. It lets me do three samples over time. I’m going to do one this week, then another in about two months and probably one right when I get sick again.

The other podcast guys are most likely going to do it too so we can compare results. I’m guessing the company will also have some guidelines for what a healthy gut looks like.

I had severe heartburn for over a decade. Visited multiple doctors, took prescription meds, and had routine endoscopy. I finally visited a natural doctor who helped me determine I was allergic to dairy. The prescription meds actually made the problem much worse because they reduced gut acid and messed up the gut biome. It took 9 months of no diary, weaning off medication, and taking probiotics but I finally got rid of the heartburn for good. Just a thought to keep in mind while you are on this journey…most doctors are great but it seems they often try to treat symptoms instead of finding the root cause. It’s not just the doctors. It’s a culture that is driven by multi-billon dollar companies.

I always get sick in the winter at least once but nothing like you experience. I didn’t get sick last year by doing 3 things.

Wash hands all the time. Wash when arriving at work. When leaving work. When arriving home. Before bed. etc. Also have a bottle of hand sanitizer at your desk, car, etc.

Dont touch your face. Seems odd but I think many people habitually touch their face/nose.

I don’t know the precise number for the US, but in central europe around 1% are affected by G6PDD (for the whole world population the percentage is even higher, around 7.5%). Holy cow, that is A LOT of people!

Is it me, or does this jar look a bit intimidating now? (btw even it’s pollen is a trigger)